Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | D0053570 | MD |
NPI | 1093824500 |
---|---|
Provider Name | Dr. Lori Smith Garcia |
First Address | Odenton, MD 21113-1004 |
Second Address | Baltimore, MD 21229-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 16/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
421901500 | (05) | MD |